What's happening
This bill requires insurance policies covering prescription drugs in New York to also cover supplements, vitamins, medical foods, and other medications needed to treat mitochondrial disease.
Why it matters
Expands insurance coverage to include supplements, vitamins, and medical foods. that are often excluded, making it easier for patients with mitochondrial disease to obtain necessary treatments that may not be classified as traditional pharmaceuticals.
Relies on physician judgment for coverage eligibility. , ensuring that only those supplements and treatments deemed medically necessary for mitochondrial disease—based on clinical, biopsy, biochemical, or genetic evidence—are covered, potentially reducing disputes and delays in care.
May reduce out-of-pocket costs for affected families. , who currently might have to pay entirely out-of-pocket for expensive, ongoing dietary supplements essential for managing mitochondrial disease symptoms.
Could set a precedent for insurance treatment of rare diseases. , possibly influencing future policy changes for coverage of non-traditional therapies for other chronic, rare, or metabolic conditions.
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Who cares
Headline styles
Cover Supplements for Mito Disease
Plain English, a few words. Used as the page title.
Sponsors
1 Co-sponsor
History
- Referred to insurance
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Cover Supplements for Mito Patients
In Assembly Committee · Insurance · Sponsor Patrick Burke
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3015
2019-2020 Regular Sessions
IN SENATE
January 31, 2019
Introduced by Sen. KENNEDY -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to requiring prescription drug coverage to include such supplements and vitamins, medical foods, and other medications as shall be deemed necessary to mitigate and/or treat the symptoms of mitochondrial disease
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 35 to read as follows:
(35) (A) Every policy which provides coverage for prescription drugs shall include coverage for the cost of such supplements and vitamins, medical foods, and other medications used to treat the symptoms associated with mitochondrial disease as a physician shall deem necessary to mitigate and/or treat the symptoms of such mitochondrial disease diagnosed through clinical assessment, muscle biopsy, biochemical testing or genetic testing in a covered person.
(B) Such coverage may be subject to such annual deductibles and coinsurance as may be deemed appropriate by the superintendent and as are consistent with those established for other benefits within the policy.
§ 2. Subsection (k) of section 3221 of the insurance law is amended by adding a new paragraph 22 to read as follows:
(22) (A) Every group or blanket policy delivered or issued for delivery in this state that provides coverage for prescription drugs shall include coverage for the cost of such supplements and vitamins, medical foods, and other medications used to treat the symptoms associated with mitochondrial disease as a physician shall deem necessary to mitigate and/or treat the symptoms of such mitochondrial disease diagnosed through clinical assessment, muscle biopsy, biochemical testing or genetic testing in a covered person.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04192-01-9
S. 3015 2
(B) Such coverage may be subject to such annual deductibles and coinsurance as may be deemed appropriate by the superintendent and as are consistent with those established for other benefits within the policy.
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (ss) to read as follows:
(ss) (1) Every contract issued by a corporation subject to the provisions of this article which provides coverage for prescription drugs shall include coverage for the cost of such supplements and vitamins, medical foods, and other medications used to treat the symptoms associated with mitochondrial disease as a physician shall deem necessary to mitigate and/or treat the symptoms of such mitochondrial disease diagnosed through clinical assessment, muscle biopsy, biochemical testing or genetic testing in a covered person.
(2) Such coverage may be subject to such annual deductibles and coinsurance as may be deemed appropriate by the superintendent and as are consistent with those established for other benefits within the contract.
§ 4. This act shall take effect on the first of January next succeeding the date on which it shall have become a law and shall apply to policies and contracts issued, reissued, renewed, modified or amended on or after such date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the insurance law, in relation to requiring prescription drug coverage to include such supplements and vitamins, medical foods, and other medications as shall be deemed necessary to mitigate and/or treat the symptoms of mitochondrial disease
Purpose
To require insurance policies providing prescription drug coverage to cover vitamins and supplements to mitigate the symptoms of mitochondrial disease.
Summary of provisions
Section 1 amends section 3216 of the insurance law by adding a new para- graph that requires policies that cover prescription drugs to cover the cost of vitamins, supplements, and other medications used to treat symp- toms associated with mitochondrial disease.
Section 2 amends section 3221 of the insurance law by adding a new para- graph that requires policies that cover prescription drugs to cover the cost of vitamins, supplements, and other medications used to treat symp- toms associated with mitochondrial disease.
Section 3 amends section 4303 of the insurance law by requiring all contracts issued by corporations that cover prescription drugs to cover the cost of vitamins, supplements, and other medications used to treat symptoms associated with mitochondrial disease.
Section 4 is the effective date.
Justification
Mitochondria are the powerhouse of the cell, and can be found in almost every cell in the human body. These organelles perform essential func- tions such as energy generation and breaking down waste products that could harm the cell. Patients with mitochondrial disease have mitochond- ria that cannot efficiently turn sugar and oxygen into energy. The United Mitochondrial Disease Foundation estimates that 1,000 to 4,000 children are born with mitochondrial disease every year.
Some patients have had success in mitigating symptoms with tailored prescriptions of vitamins and supplements known as 'mito-cocktails.' However, these 'mito-cocktails' are not currently covered by insurance companies and can cost over $300 per month per patient. This legis- lation would provide insurance coverage for vitamins and supplements used to mitigate the symptoms of mitochondrial disease in suffering patients.
Legislative history
2017-18: S.7826 Referred to Insurance
Fiscal implications
To be determined.
Effective date
This act shall take effect on the first of January next succeeding the date on which it shall have become a law and shall apply to policies and contracts issued, reissued, renewed, modified or amended on or after such date.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.